Provider Demographics
NPI:1821854944
Name:ALYSSA GOODWIN MD PLLC
Entity Type:Organization
Organization Name:ALYSSA GOODWIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA (NHA)
Authorized Official - Phone:207-406-4462
Mailing Address - Street 1:9 BOWDOIN MILL IS
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1263
Mailing Address - Country:US
Mailing Address - Phone:207-406-4462
Mailing Address - Fax:207-518-8961
Practice Address - Street 1:9 BOWDOIN MILL IS
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1263
Practice Address - Country:US
Practice Address - Phone:207-406-4462
Practice Address - Fax:207-518-8961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty